Procianoy Renato S, Corso Andrea Lucia, Longo Maria Gabriela, Vedolin Leonardo, Silveira Rita C
a Newborn Section, Department of Pediatrics , Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul , Porto Alegre , Brazil.
b Radiology Section, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre , Brazil.
J Matern Fetal Neonatal Med. 2019 Aug;32(16):2727-2734. doi: 10.1080/14767058.2018.1448773. Epub 2018 Mar 13.
To determine the neurodevelopment outcomes after therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy (HIE) and identify the neonatal magnetic resonance imaging (MRI) findings associated with neurological outcome in a middle-income country.
All infants born after 35 completed weeks' gestation with signs of moderate to severe encephalopathy and evidence of perinatal asphyxia before 6 hours of life were submitted to whole-body hypothermia and were imaged at 18 ± 8.4 days of life (range 7-33 days) after birth. Surviving infants had the neurodevelopment outcome assessed at 12 to 18 months of age by trained professional masked to MRI findings.
Forty-eight infants included, MRI scans were obtained from 34 infants; 14 (29.1%) patients died during hospitalization before MRI was performed. Nine (64.3%) of 14 patients were classified as severe encephalopathy presented Posterior Limb Internal Capsule (PLIC) sign at the MRI, 10 (71.4%) thalamus and basal ganglia (TBG) lesion, 9 (64.3%) white matter (WM) lesion, and 7 (50.0%) cortical lesion. Severe encephalopathy was associated with the motor delay at 12-18 months by Bayley III, Alberta Infant Motor Scale (AIMS), and Gross Motor Function Classification System (GMFCS) scores (p = .020, p = .048, p = .033, respectively), but not for the cognitive (p = .167) or language skills (p = .309). Lower BSID-III motor, cognitive, and language composite scores were associated with PLIC sign (p = .047; p = .006 and p = .003, respectively). TBG lesion (p = .051) and cortical lesion (p = .030) were associated with lower language composite score. Motor delay by AIMS and the presence of PLIC sign, TBG lesion, WM lesion, and Cortical lesion on MRI were observed (p < .001; p = .002; p = .001 and p = .027, respectively); as well as higher GMFCS score were associated with the presence of PLIC sign, TBG lesion, WM lesion, and Cortical lesion on MRI (p < .001; p = .001; p = .001, and p = .011, respectively).
Brain MRI in neonates with HIE after therapeutic hypothermia is a valuable tool for diagnosis of encephalopathy cerebral abnormalities and is an early predictor of outcome in infants treated with whole body hypothermia for HIE in the Brazilian experience.
确定新生儿缺氧缺血性脑病（HIE）治疗性低温治疗后的神经发育结局，并在一个中等收入国家中确定与神经学结局相关的新生儿磁共振成像（MRI）表现。
所有孕35周后出生、有中度至重度脑病体征且出生后6小时内有围产期窒息证据的婴儿均接受全身低温治疗，并在出生后18±8.4天（7 - 33天）进行成像。存活婴儿在12至18个月龄时由对MRI结果不知情的训练有素的专业人员评估神经发育结局。
纳入48例婴儿，34例婴儿进行了MRI扫描；14例（29.1%）患者在进行MRI检查前住院期间死亡。14例患者中有9例（64.3%）被归类为重度脑病，MRI表现为内囊后肢（PLIC）征，10例（71.4%）丘脑和基底节（TBG）病变，9例（64.3%）白质（WM）病变，7例（50.0%）皮质病变。重度脑病与12 - 18个月时贝利婴幼儿发育量表第三版（Bayley III）、艾伯塔婴儿运动量表（AIMS）和粗大运动功能分类系统（GMFCS）评分的运动发育迟缓相关（分别为p = 0.020、p = 0.048、p = 0.033），但与认知（p = 0.167）或语言技能（p = 0.309）无关。较低的贝利婴幼儿发育量表第三版运动、认知和语言综合评分与PLIC征相关（分别为p = 0.047；p = 0.006和p = 0.003）。TBG病变（p = 0.051）和皮质病变（p = 0.030）与较低的语言综合评分相关。观察到AIMS评估的运动发育迟缓以及MRI上PLIC征、TBG病变、WM病变和皮质病变的存在（分别为p < 0.001；p = 0.002；p = 0.001和p = 0.027）；以及较高的GMFCS评分与MRI上PLIC征、TBG病变
